RX for confusion

For 19-year-old Sean Flanagan, the heartbreaking diagnosis came on the day, two years ago, when he hoped Denver's Children's Hospital doctors would tell him he was free of cancer.

The previous year, he'd been through nearly every treatment modern medicine could throw at him: surgery to remove a football-sized tumor from his pelvis, bone marrow transplants, skin-slaking radiation therapy, a leg amputation and various chemotherapies.

It hadn't been enough. Ewing's sarcoma, a rare cancer that strikes most commonly in teenagers, had won the chemical war. To the doctors, the purple tumor knobs on Sean's stump said it all.

If conventional medicine had failed their son, Dave and Laura Flanagan asked themselves, what about alternatives? Weren't there safe natural remedies that could be tried?

The Centennial couple hired Brian O'Connell, who claimed to be an N.M.D., or naturopathic medical doctor. A wall full of credentials and certificates decorated his practice, Mountain Area Naturopathic Associates in Wheat Ridge, a suburb northwest of Denver.

Dave Flanagan says they wanted to help Sean live out his remaining months in less pain. O'Connell, he says, promised to do a lot better: He said he'd save their son. "He said, 'No Irish kid's going to die on my watch.'"

In the first of four treatments, O'Connell injected the teenager with hydrogen peroxide and withdrew his blood with the same syringe. The blood then was exposed to a UV light machine before being returned to his body -- a process called "photoluminescence." Meanwhile, an IV drip administered a cocktail of vitamins into the bloodstream.

Nine days after beginning this treatment, the oxygen level in Sean's veins plummeted to around 18 percent of its normal level, and the teen's skin turned grey. He died on Dec. 19, 2003.

O'Connell was arrested three months later and subsequently booked on 14 counts, including reckless manslaughter, multiple assaults, fraud, theft, practicing medicine without a license, and possession of controlled substances. Dave and Laura Flanagan watched the arrest on TV with horror.

Sean Flanagan isn't the only patient listed in the case against O'Connell, who is charged with assaulting a number of other patients. One went into cardiac arrest, and another died with large open wounds after O'Connell brought him to the emergency room at Lutheran Medical Center in Wheat Ridge.

But Flanagan's grisly death has become a flashpoint in an increasingly heated battle over whether alternative, or naturopathic, doctors should be regulated in Colorado.

Proponents of regulation argue that O'Connell never should have been able to present himself as a naturopathic doctor, because he possessed only flimsy credentials. Police discovered that Flanagan's training in naturopathic medicine had been a correspondence course from the Herbal Healer Academy in Mountain View, Ark.

In the summer of 2004, following his arrest, O'Connell allegedly began seeing patients again. He subsequently was slapped with another round of criminal charges. Lack of oversight, regulation proponents say, allowed him to prey on ignorant consumers.

O'Connell could not be reached, and his attorney declined comment for this story. He goes to trial on Jan. 31 at the Jefferson County District Court in Golden.

Colorado's freewheeling marketplace

Pointing at the O'Connell case and others, the state's Department of Regulatory Agencies (DORA) agreed this fall that something needed to be done.

Having studied the issue for more than 10 years and having issued two previous reports on the topic, the state's professional credentialing agency put its weight behind an application to regulate naturopathic doctors in Colorado. Failure to license qualified naturopathic doctors puts citizens at risk by allowing an unsafe marketplace, according to its report issued Oct. 14.

The recommendation was greeted with gratitude by many of the 84 practicing naturopathic doctors in Colorado, including at least four in Colorado Springs, who arguably have the right to call themselves "doctors" under the state's Consumer Protection Act because they've earned U.S. Department of Education-approved postgraduate degrees in natural medicine.

"More and more people are interested in this kind of care," says Rena Bloom, a Denver naturopathic doctor and president of the Colorado Association of Naturopathic Physicians, made up of naturopaths who have earned accredited degrees.

Unlike O'Connell, doctors who graduate from one of the three nationally accredited four-year residential colleges (or from a fourth college currently a candidate for accreditation) study a wide range of alternative treatments. They base those treatments on a foundation of conventional, science-based medical training.

Dave and Laura Flanagan, of Centennial, lost their son Sean to cancer just days after Brian OConnell began what they say he promised would be life-saving treatments. Police later discovered that although OConnell called himself a naturopathic medical doctor, his training consisted only of a correspondence course.

Naturopathic doctors, or N.D.s, offer themselves as guides through the expanding maze of available alternative remedies, including herbs, diet changes and homeopathy.

The key difference between naturopaths and conventional medical doctors is the naturopathic philosophy that the body can heal itself if treated holistically, not just through attacking individual symptoms with surgery and drugs.

The ranks of formally trained naturopaths have steadily grown across the country over the last 20 years. Fifteen states and the nation's capital now offer them licenses as primary care providers.

But the resistance to legitimizing them has grown, too.

They face opposition from many medical doctors who call them "quacks," and who view alternative remedies as scientifically unproven and threatening to their own practices.

Even more fiercely opposed to the idea of licensing alternative doctors in Colorado are the multitude of less formally trained healers, many of whom boast correspondence course degrees. They often prefer Colorado's current freewheeling marketplace and fear that licenses would lock them out of a thriving business.

The battle between all camps is likely to be ferocious if Colorado's Legislature, which holds the power to create professional licensing boards, takes up the issue within the next two years.

Although naturopath licensure bills have been introduced and failed three times before -- in 1993, 1995 and 1999 -- the DORA recommendation and the O'Connell case may create a tipping point.

Rigorous training

In looking for an alternative doctor, the Flanagan family wasn't acting out of the mainstream.

At least one-third of all Americans now complement standard medicine with some kind of alternative care, such as naturopathy, acupuncture or massage therapy, according to a study by The New England Journal of Medicine.

That amounts to a $40 billion industry annually, according to some estimates.

"I was not attracted to surgery, I was not attracted to drug therapy," says Bloom, who says she easily could have pursued a degree in conventional medicine after going pre-med at the University of Massachusetts in the 1980s.

But her heart was drawn to alternative care. "I was interested in teaching people what they could do to become healthy," she says. "The combination of studying medicine with natural therapies was, to me, a perfect fit."

Earning a four-year doctorate in naturopathy from the National College of Naturopathic Medicine in Portland, Ore., suited her pragmatic personality.

Students there spend the first two years of study immersed in classes similar to those taken by med-school students, including anatomy, physiology, pediatrics and obstetrics, and going through other rigorous training. During the third and fourth years, the focus is naturopathic, on things such as diet regimes, botanical medicine and pharmacology for natural remedies. Meanwhile, students complete more than 1,500 hours of clinical internship study with both licensed naturopathic physicians and conventional medical doctors.

National College is one of three fully accredited institutions offering N.D. degrees. A fourth, the University of Bridgeport in Connecticut, is approaching its fifth year of candidacy status with the Council on Naturopathic Medical Education.

After earning her degree in 1991, Bloom applied for and received a license to practice naturopathy in Oregon. But instead of practicing there, she and her husband, also a naturopath, moved to uncharted territory.

"We didn't waste any time," she says. "We moved here and got hopping right away."

Although Colorado didn't offer licenses, the pair established a practice in Denver in 1992 that, like the health alternative marketplace, began to thrive.

"When we first moved to Denver in 1992, if you wanted echinacea or glucosamine sulfate, you went to Alfalfa's, Wild Oats or the co-op," she says. These days, "customers shop for herbs at CostCo, a Walgreens and Target."

In 1993, Bloom found an ally in the fight for recognition in then-state Rep. Russell George, a Republican from Rifle.

"He looked at us and said, 'Let me get this straight. You're well-trained. You're offering a service to the citizens of Colorado that they want and appreciate, and you're practicing medicine without a license?'

"We said, 'Uh huh.'

"And he said, 'Well something needs to be done about that.' And from that day forth, he sponsored our bills."

From 1993 until 1999, George, who became speaker of the house, championed bills to regulate naturopaths.

Although bills failed in 1993 and 1995, the stars appeared to have aligned for licensure in 1999. The Colorado Medical Society -- the state's largest membership society of medical doctors and students -- agreed to not oppose licensing if the law stated that naturopaths would not prescribe medicine, do minor surgery, deliver babies or use the title of "physician."

The bill appeared poised for approval.

Then, everything went haywire.

On April 20, 1999, the Columbine school massacre happened. Uproar followed at the state Capitol, and all other issues got pushed back.

When Bloom finally was invited to the State House to make what she had expected to be a simple presentation, licensing opponents had come out in full force.

"The basement was swarming with people with these big buttons on. It was one of these 'No!' buttons with our bill number on it."

As many as 150 people flooded the hearing room, prompting the senators to move to a larger space. Dozens of people rose to speak against licensing naturopaths, the first being a stocky man named Boyd Landry.

Landry, executive director of the Washington D.C.-based Coalition for Natural Health, a nonprofit organization that fights against licensing naturopaths, had mobilized the bill's ambush.

To this day, George, now executive director of the state's Department of Natural Resources, remains convinced that regulating alternative doctors is the right thing to do.

"The more I learned, the more impressed I was to learn how well-trained they are, how strong their academic training is," he says.

He, too, was surprised by the sudden emergence of the activists in the Senate chamber. "When you have that much noise in the system, it's hard to accomplish anything."

Landry's group is largely funded by corporate sponsors from the natural supplement industry. The massive industry wants to ensure that their products aren't targeted for further regulation by the Food and Drug Administration.

Landry, who has no medical background, has been successful in supporting "health freedom" laws in six states that guarantee the right to dispense non-medical alternative care without a license. Focusing on who should be called a "doctor," he says, isn't important.

And as for the risks of allowing dangerous novices to call themselves doctors, Landry is dismissive.

"Doctors kill people all day long," he says. "That's why we have malpractice."

The case of Mark Cooper

But the idea of regulation makes a lot of sense to one of the naturopathic doctors listed in Colorado's DORA report.

Mark Cooper, an accredited-school naturopath and licensed acupuncturist, runs the Alpine Naturopathic Clinic in Colorado Springs. He can attest that the state's lack of regulation poses risks for the practitioner as well as the patient.

Cooper graduated from National College in the same year as Bloom. Like Bloom, he operates a thriving practice and has forged working relationships with several local medical doctors. Most of his patients come to him, he says, "because they've exhausted their options to treat their diseases."

Last summer, Cooper became the focus of an investigation, and ultimately was sued for practicing medicine without a license, by Colorado Attorney General John Suthers.

But unlike O'Connell, the Wheat Ridge naturopath, no one was accusing Cooper of having harmed anyone.

The lawsuit, he says, had more to do with retaliation for providing primary care as an alternative doctor.

"The people who lashed out at me never even met me," Cooper says of the two Colorado Springs medical doctors who pushed to bring the action against him.

In 2002, Cooper successfully removed a patient's abscessed hemorrhoid; in 2004, he sold a thyroid medication to a patient. He was trained to perform both procedures, but because he has no license, he was accused of illegally practicing medicine.

Cooper settled the case last fall, signing an injunction that says he will refrain from writing prescriptions and doing surgery, injections and IV therapy.

Although he plans to fully honor the terms of the injunction, he chalks the penalty and the thousands of dollars he spent fighting the lawsuit up to a "turf war" between naturopathic care and conventional medicine.

"I'm interfering in an economic business in Colorado Springs," he says, calling the lawsuit "financial retaliation." With no regulation, it's easy for M.D.s to wield current laws to discriminate against naturopaths and keep them on unsure ground by resisting the creation of a scope of practices for naturopathic doctors.

Cooper says the same exclusionary tactics have been employed against other medical disciplines throughout history: Chiropractors had to battle for legitimacy but now are licensed in all 50 states; pharmacists used to be prohibited from patient counseling; and so on.

"Regulation in health care," Cooper says, "is almost exclusively to the patient's benefit."

And it also could be to the benefit to M.D.s, he says, because with regulation, he'd be able to cooperate more openly with the medical establishment and refer more patients to conventional physicians.

Giving legitimacy

Last year, delegates of the Colorado Medical Society -- the same organization that was neutral on naturopathic regulation in 1999 -- voted to strongly oppose regulation of alternative doctors.

2005 Bruce Elliott

Colorado Springs naturopath Mark Cooper.

Laura Pomerenke, a surgeon and president of the El Paso County Medical Society, explains.

"When you license someone, you're giving them, in terms of the public, some kind of legitimacy," she says.

Indeed, despite high salaries -- the 2003 U.S. median salary for family physicians was $146,000 a year, according to the University of Virginia -- medical doctors are not immune from professional jealousy and greed.

And many medical doctors can sense the shift in the medical marketplace towards holistic prevention, natural remedies and organics. Even though at least a third of Americans consult with alternative care providers, some 75 percent of them don't tell their medical doctors they are doing so, according to a 1997 report from the Council on Scientific Affairs.

"We've all worked pretty hard to become doctors. You want to make sure if they're calling themselves a doctor, you want to know their standards," Pomerenke says. "What is the standard of care for naturopathic medicine? I don't know."

'All about balancing'

Despite strenuous resistance from some pockets of the medical community, the resistance to licensing naturopaths may be fading nationwide.

One of a small community of academics studying the regulation of the current alternative medicine boom is Michael H. Cohen, an assistant professor at Harvard Medical School.

"It's all about balancing," he says. "A person has the right to say what will happen with his own body."

Naturopaths who have gone through rigorous training but operate in unlicensed states "are at risk," he notes. "They operate in a grey zone."

But the antagonism that currently bristles between naturopaths and M.D.s in Colorado may give way to new cooperative relationships, he says.

"Cross-referral is probably the wave of the future," he says.

That evolution of consciousness may not happen fast enough in Colorado, says Laura Flanagan. Now a big proponent of regulation, Flanagan hopes she can help prevent the kind of tragedy that may have robbed her son's last months of life.

"We need to continue to push and let people know about this," she says about the fight to regulate naturopaths, "so that people like [O'Connell] won't have such easy access to the public."

Despite a growing interest in alternative care, the Colorado Medical Society opposes regulation of non-medical doctors. Last year, the organization adopted the following positions, which Rena Bloom, president of the Colorado Association of Naturopathic Physicians, calls "borderline offensive":

Naturopathic methods haven't been proven safe and effective.

There's no clear scope of their practice.

Regulating them would be problematic.

There's no way to determine who would be a deserving candidate for licensure.

There's no way to distinguish the claims of one group of naturopaths from another.

Only 35 naturopaths are seeking licensure, and if they self-regulate, they would have a conflict of interest.

Science shows that naturopathic practice is substandard medical practice, and some of its practices are unacceptable.

There are no scientific principles that distinguish what naturopaths do from what medical and osteopathic doctors already do, therefore showing no social or professional need for naturopathy.

Collaboration between medical doctors and naturopaths is "untenable" because of "irreconcilable scientific and ethical differences."

Naturopaths portray themselves as primary care physicians even through their training is substandard.